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Individual

LYA KUSHNIROVICH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PSY.D.

Contact information

Practice address
3250 ZEMKE AVE BLDG 1078, TAMPA, FL 33621-5023
(813) 827-9170
Mailing address
4832 COBIA DR SE, APT B, SAINT PETERSBURG, FL 33705-4896
(917) 837-1747

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY 9734
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1386694701
JAMES A. HALEY VA
FL
Enumeration date
11/05/2016
Last updated
04/10/2018
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